Total Hip Arthroplasty Among Superobese Patients: Proceed With Caution
Background: Morbid obesity, defined as body mass index (BMI) ≥40 kg/m2, increases perioperative risk following total hip arthroplasty (THA). However, limited contemporary data exists on outcomes of superobese patients (BMI ≥50 kg/m2) following primary THA. Using a large modern cohort, this study see...
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Elsevier
2025-08-01
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| Series: | Arthroplasty Today |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2352344125001578 |
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| author | Sagar Telang, MD Ryan Palmer, MD Brian C. Chung, MD Jacob R. Ball, MD Kurt Hong, MD PhD Jay R. Lieberman, MD Nathanael D. Heckmann, MD |
| author_facet | Sagar Telang, MD Ryan Palmer, MD Brian C. Chung, MD Jacob R. Ball, MD Kurt Hong, MD PhD Jay R. Lieberman, MD Nathanael D. Heckmann, MD |
| author_sort | Sagar Telang, MD |
| collection | DOAJ |
| description | Background: Morbid obesity, defined as body mass index (BMI) ≥40 kg/m2, increases perioperative risk following total hip arthroplasty (THA). However, limited contemporary data exists on outcomes of superobese patients (BMI ≥50 kg/m2) following primary THA. Using a large modern cohort, this study seeks to quantify the risk of infection and surgical, medical, and thromboembolic complications among superobese THA patients. Methods: The Premier Healthcare Database was queried to identify all primary elective THA patients between 2016 and 2021. All superobese patients were compared to a normal BMI cohort (BMI 18.5-24.9 kg/m2). Univariate analysis and multivariable regression were utilized to assess differences in primary outcomes, including 90-day infectious, surgical, medical, and thromboembolic complications. Results: Twenty-one thousand, thirty-five THA patients were identified; 888 patients (4.2%) had a BMI ≥50 kg/m2, while 20,147 patients (95.8%) had a BMI 18.5-24.9 kg/m2. On multivariable analysis, superobese patients demonstrated an increased risk of infectious and surgical complications, including periprosthetic joint infection (adjusted odds ratio [aOR]: 7.23, 95% confidence interval (CI): 3.95-13.24, P < .001), sepsis (aOR: 4.24, 95% CI: 2.19-9.23, P < .001), and wound dehiscence (aOR 7.61, 95% CI: 3.90-14.85, P < .001). The risk of pulmonary embolism (aOR 4.32, 95% CI: 1.75-10.64, P = .001), acute respiratory failure (aOR: 2.31, 95% CI: 1.32-4.05, P = .003), acute renal failure (aOR: 3.15, 95% CI: 2.19-4.52, P < .001), and hospital readmission (aOR: 2.31, 95% CI: 1.75-3.07, P < .001) were similarly elevated within the superobese cohort. Conclusions: Superobese patients face markedly increased risk for infection and surgical, medical, and thromboembolic complications following primary THA. Our findings emphasize the importance of preoperative risk stratification, optimization, and patient counseling in this high-risk cohort. |
| format | Article |
| id | doaj-art-287808c8fc2946eb8092e730e7674fdb |
| institution | Kabale University |
| issn | 2352-3441 |
| language | English |
| publishDate | 2025-08-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Arthroplasty Today |
| spelling | doaj-art-287808c8fc2946eb8092e730e7674fdb2025-08-20T03:50:22ZengElsevierArthroplasty Today2352-34412025-08-013410177010.1016/j.artd.2025.101770Total Hip Arthroplasty Among Superobese Patients: Proceed With CautionSagar Telang, MD0Ryan Palmer, MD1Brian C. Chung, MD2Jacob R. Ball, MD3Kurt Hong, MD PhD4Jay R. Lieberman, MD5Nathanael D. Heckmann, MD6Department of Orthopaedic Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA; Department of Orthopaedic Surgery, University of California, Davis School of Medicine, Sacramento, CA, USADepartment of Orthopaedic Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USADepartment of Orthopaedic Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USADepartment of Orthopaedic Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USACenter for Clinical Nutrition, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USADepartment of Orthopaedic Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USADepartment of Orthopaedic Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA; Corresponding author. 1520 San Pablo Street, Ste 2000, Los Angeles, CA 90333, USA. Tel: +1 323 704 6363.Background: Morbid obesity, defined as body mass index (BMI) ≥40 kg/m2, increases perioperative risk following total hip arthroplasty (THA). However, limited contemporary data exists on outcomes of superobese patients (BMI ≥50 kg/m2) following primary THA. Using a large modern cohort, this study seeks to quantify the risk of infection and surgical, medical, and thromboembolic complications among superobese THA patients. Methods: The Premier Healthcare Database was queried to identify all primary elective THA patients between 2016 and 2021. All superobese patients were compared to a normal BMI cohort (BMI 18.5-24.9 kg/m2). Univariate analysis and multivariable regression were utilized to assess differences in primary outcomes, including 90-day infectious, surgical, medical, and thromboembolic complications. Results: Twenty-one thousand, thirty-five THA patients were identified; 888 patients (4.2%) had a BMI ≥50 kg/m2, while 20,147 patients (95.8%) had a BMI 18.5-24.9 kg/m2. On multivariable analysis, superobese patients demonstrated an increased risk of infectious and surgical complications, including periprosthetic joint infection (adjusted odds ratio [aOR]: 7.23, 95% confidence interval (CI): 3.95-13.24, P < .001), sepsis (aOR: 4.24, 95% CI: 2.19-9.23, P < .001), and wound dehiscence (aOR 7.61, 95% CI: 3.90-14.85, P < .001). The risk of pulmonary embolism (aOR 4.32, 95% CI: 1.75-10.64, P = .001), acute respiratory failure (aOR: 2.31, 95% CI: 1.32-4.05, P = .003), acute renal failure (aOR: 3.15, 95% CI: 2.19-4.52, P < .001), and hospital readmission (aOR: 2.31, 95% CI: 1.75-3.07, P < .001) were similarly elevated within the superobese cohort. Conclusions: Superobese patients face markedly increased risk for infection and surgical, medical, and thromboembolic complications following primary THA. Our findings emphasize the importance of preoperative risk stratification, optimization, and patient counseling in this high-risk cohort.http://www.sciencedirect.com/science/article/pii/S2352344125001578Super-obesityObesityTotal hip arthroplastyPeriprosthetic joint infectionComplication |
| spellingShingle | Sagar Telang, MD Ryan Palmer, MD Brian C. Chung, MD Jacob R. Ball, MD Kurt Hong, MD PhD Jay R. Lieberman, MD Nathanael D. Heckmann, MD Total Hip Arthroplasty Among Superobese Patients: Proceed With Caution Arthroplasty Today Super-obesity Obesity Total hip arthroplasty Periprosthetic joint infection Complication |
| title | Total Hip Arthroplasty Among Superobese Patients: Proceed With Caution |
| title_full | Total Hip Arthroplasty Among Superobese Patients: Proceed With Caution |
| title_fullStr | Total Hip Arthroplasty Among Superobese Patients: Proceed With Caution |
| title_full_unstemmed | Total Hip Arthroplasty Among Superobese Patients: Proceed With Caution |
| title_short | Total Hip Arthroplasty Among Superobese Patients: Proceed With Caution |
| title_sort | total hip arthroplasty among superobese patients proceed with caution |
| topic | Super-obesity Obesity Total hip arthroplasty Periprosthetic joint infection Complication |
| url | http://www.sciencedirect.com/science/article/pii/S2352344125001578 |
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